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Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity.

Publication ,  Journal Article
Auch, E; Barbachan Mansur, NS; Alexandre Alves, T; Cychosz, C; Lintz, F; Godoy-Santos, AL; Baumfeld, DS; de Cesar Netto, C
Published in: Foot Ankle Int
June 2021

BACKGROUND: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. METHODS: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. RESULTS: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% (P < .001) in FAO and 10.4 mm2 (P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 (P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. CONCLUSION: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

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Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2021

Volume

42

Issue

6

Start / End Page

768 / 775

Location

United States

Related Subject Headings

  • Weight-Bearing
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Foot Deformities
  • Case-Control Studies
  • Ankle Joint
  • 4207 Sports science and exercise
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences
 

Citation

APA
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Auch, E., Barbachan Mansur, N. S., Alexandre Alves, T., Cychosz, C., Lintz, F., Godoy-Santos, A. L., … de Cesar Netto, C. (2021). Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity. Foot Ankle Int, 42(6), 768–775. https://doi.org/10.1177/1071100720982907
Auch, Elijah, Nacime Salomao Barbachan Mansur, Thiago Alexandre Alves, Christopher Cychosz, Francois Lintz, Alexandre Leme Godoy-Santos, Daniel Soares Baumfeld, and Cesar de Cesar Netto. “Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity.Foot Ankle Int 42, no. 6 (June 2021): 768–75. https://doi.org/10.1177/1071100720982907.
Auch E, Barbachan Mansur NS, Alexandre Alves T, Cychosz C, Lintz F, Godoy-Santos AL, et al. Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity. Foot Ankle Int. 2021 Jun;42(6):768–75.
Auch, Elijah, et al. “Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity.Foot Ankle Int, vol. 42, no. 6, June 2021, pp. 768–75. Pubmed, doi:10.1177/1071100720982907.
Auch E, Barbachan Mansur NS, Alexandre Alves T, Cychosz C, Lintz F, Godoy-Santos AL, Baumfeld DS, de Cesar Netto C. Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity. Foot Ankle Int. 2021 Jun;42(6):768–775.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2021

Volume

42

Issue

6

Start / End Page

768 / 775

Location

United States

Related Subject Headings

  • Weight-Bearing
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Foot Deformities
  • Case-Control Studies
  • Ankle Joint
  • 4207 Sports science and exercise
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences